Author Archives: admin

Health Reform and Drugs, Drugs, Drugs

The good news. On Wednesday, November 19, CoOportunity Health, the Iowa-Nebraska health-care-cooperative insurance entity that I have touted in several blog posts, insured its 100,000th person for health-care coverage. As I have said before, its projection for the end of this year, its first year of operation, was 15,000 policyholders.

The bad news. CoOportunity Health announced that next year, 2015, it would not participate in the Iowa Medicaid expansion for individuals whose incomes were between 100 to 133 percent of the federal poverty level (FPL). CoOportunity Health simply could not sustain the financial losses for this group of 11,000 Iowans. From my non-insurance and non-actuarial level of understanding, the major issues were 1) the federal government being unwilling to allow for a separate, more accurate actuarial premium amount for this population of newly insured individuals and instead requiring this population to be part of the entire population’s actuarial projection of CoOportunity Health’s premium holders, and 2) the high cost of drugs for treatment of diseases such as Hepatitis C and HIV. For now, this group of individuals will be part of the Medicaid program instead of utilizing the Exchange and being part of the private insurance system.

In this post I’ll discuss several incidents of how the high cost of medicines has negatively affected my patients and the health-care system. The question is: Can health reform, or for that matter the health-care system, survive the upward trajectory of the price of medications?

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Health Reform and the 2014 Iowa Senate Race

I ask the few remaining independent voters — those who have not yet decided for whom they will vote in the U.S. Senate race between Iowa State Senator Joni Ernst and U.S. Congressman Bruce Braley — to give me two minutes of your time.

I am Dave Carlyle, a family physician and hospice medical director from Ames. I grew up in Denison. This is where, during my summers home from college, I learned the value of hard work by sweating 10 hours a day at the Iowa Beef Packers slaughterhouse. After medical school at the University of Iowa and family-medicine residency in Waterloo, I practiced nine and a half years in Kossuth County. I have now practiced 21 years in Ames. My family has been serving Iowans for 160 years. My two daughters, both of whom are physicians, also care for Iowans.

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Health Reform and Health Coaches

Preparing for this blog entry and for an upcoming talk regarding health coaches, I asked one of my health coaches to share a memory she had about when she had connected with one of my patients in an especially meaningful way. To put this memory in perspective, my health coaches see my diabetic patients and patients who are having Medicare physicals before I see these patients. My health coach shared a memory from one of these preparatory visits with a diabetic patient who had recently learned of the violent death of her sister. My health coach spent a few minutes with this grieving patient before I entered the room. Because the patient had known and worked with this health coach for more than a year, they were able to connect, and I believe that the patient felt fully supported by my practice in the person of this health coach.

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Health Reform and a Governor Hatch Administration

One of my proudest moments, which was photographed — the photo is displayed in my office at the clinic — is the 1998 signing ceremony for the Healthy and Well Kids in Iowa (HAWK-I) program. I stood with representatives of several medical societies and an Iowa family that included a mom and three daughters while Governor Branstad signed into law a program that helped to make Iowa a leader in the nation in the percentage of insured children.

I worked long and hard with Democratic legislators, Republican Representative Brad Hansen, who also is in photo, and Republican Senator Nancy Boettger to create a program made possible by federal funding that created a public-private system to insure children. For my efforts, in 1999 I received a national Public Health Award from the American Academy of Family Physicians. During the negotiations for the HAWK-I bill, I clearly remember that then-Governor Branstad did not want a quasi-independent board to supervise the program.  He stated that in his administration he did not want to add “silos” that prevented him from overseeing the actions of state government.

Fast forward to 2013-2014.

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Health Reform and Reminiscences of Hospice Patients

This blog is dedicated to a good friend and patient of mine who died last month in hospice. I had taken care of her for 15 years. We had many remarkable and enjoyable conversations regarding her growing up in a home where her father was a physician. She thought very highly of her father and the profession of medicine. She knew the value of good medical care and how much it means to all of us, even physicians and their families. She had seen the human side of medicine in its effects on her father and her family.

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Health Reform and Answers from Iowa Candidates

Over the past months I have been inundated with requests for campaign contributions, and I looked for a way in which to make informed decisions about which candidates to support. In last month’s blog post, I shared two questions I posed to Iowa candidates running for U.S. Congress, the Iowa governorship, and the Iowa Legislature. The questions asked were an effort to engender better knowledge of just two of the complex issues surrounding the Affordable Care Act (ACA). At that time, I said I would make a $1,000 campaign contribution to the candidate who provided the most-specific answers to my questions and allow the responses to be posted on this blog. If I received thoughtful responses from several candidates, the $1000 contribution would be shared.

To date, I have received only one response, that of Senator Jack Hatch, who is running for Iowa governor. I have posted his response below. I sincerely appreciate Senator Hatch’s response. The opportunity for candidates to submit a response to my questions remains open until August 15. S.S. McClure, editor and publisher of McClure’s Magazine, once said, “The vitality of democracy depends on popular knowledge of complex questions.”  I seek candidates’ answers for just two of the many complex questions surrounding the ACA. Please let the candidates you support know about this campaign-contribution opportunity. Help me share “popular knowledge about complex questions.”

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Health Reform and Questions for Iowa Candidates

During the Golden Age of Journalism, S.S. McClure, editor and publisher of McClure’s Magazine, who is credited with developing some of the best journalists of the 19th century, said, “The vitality of democracy depends on popular knowledge of complex questions.”

Complex questions are currently before the public involving health care, and, specifically, the unfolding and future of the Affordable Care Act (ACA) or Obamacare are clearly among the most complex questions our society faces.

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Health Reform, Celebrating, and Parenthood

Celebrate! I celebrate the birth of my granddaughter and the birth and growth of CoOportunity Health. This week, as I drove with my wife and my 2-and-a-half-year-old grandson across the city of Des Moines so we all could meet my newborn granddaughter, I pondered the emotions involved with parenthood: the pride that — even as a grandparent, with only a small part in the creation of this tiny, new life — is still an overwhelming emotion, responsibility, joy, and sincere thanks. Each of these emotions fill a parent, grandparent, or godparent. At the baby’s birth on Tuesday evening, May 27, I was so moved and will continue to be throughout this beautiful child’s life into her adulthood.

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Health Reform and a Modest Proposal: Outsourcing the Federal Exchange

In previous blog posts, I have attempted to highlight the absolutely critical need for a functional, user-friendly Exchange for Iowa as outlined in the blueprint for health reform that the Affordable Care Act (ACA) laid out. Iowa’s failure, at the beginning of the ACA process, to establish an Iowa-exclusive Exchange — an Exchange operated by Iowans for the exclusive enrollment of Iowans — resulted in a hybrid or partnership between the state of Iowa and the federal Exchange (www.healthcare.gov). The results of that partnership have been neither reliably functional nor user-friendly. On Monday, March 31, I met with members of Senator Tom Harkin’s staff in Washington, D.C., and presented to them the following proposal. The proposal is self-explanatory. Since then, there are reports that the state of Iowa has applied for federal resources from the Department of Health and Human Services to plan for a state-managed, state-government-operated Exchange.

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Health Reform and “Reprehensible”

Words, at one time or another, have a profound impact on us. As I have watched some of the television commercials currently running and that will, undoubtedly, continue to run, paid for by out-of-state entities, falsely describing the Affordable Care Act (ACA), most often referred to as Obamacare, one word came to mind: reprehensible. Reprehensible is an adjective that declares something morally wrong, evil or disgraceful. My wife added that it seems also to imply the term dastardly. Both words are consistent in describing these too-often-seen commercials.

These commercials imply that the ACA has exorbitantly raised insurance premiums for individuals and denied others the opportunity to renew their insurance policies from last year. This is simply not true when applied to the effects of the ACA in Iowa.

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